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Preventing CHRONIC DISEASES a vital investment

Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

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Page 1: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

PreventingCHRONIC DISEASES

a vital investment

Page 2: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Luciano dos Santos, like 250 million others, suffers from disabling

hearing loss. How will we ensure a healthy future for children like

Luciano and the millions of others facing chronic diseases?

Page 3: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

This report shows that the impact

of chronic diseases in many low and

middle income countries is steadily

growing. It is vital that the increasing

importance of chronic disease is

anticipated, understood and acted upon

urgently. This requires a new approach

by national leaders who are in a

position to strengthen chronic disease

prevention and control efforts, and

by the international public health

community. As a fi rst step, it is essential

to communicate the latest and most

accurate knowledge and information

to front-line health professionals and

the public at large.

THE PROBLEM80% of chronic disease deaths occur in low and middle income countries and these deaths occur in equal numbers among men and women

The threat is growing – the number of people, families and communities affl icted is increasing

This growing threat is an under-appreciated cause of poverty and hinders the economic development of many countries

THE SOLUTIONThe chronic disease threat can be overcome using existing knowledge

The solutions are effective – and highly cost-effective

Comprehensive and integrated action at country level, led by governments, is the means to achieve success

THE GOALAn additional 2% reduction in chronic disease death rates worldwide, per year, over the next 10 years

This will prevent 36 million premature deaths by 2015

The scientifi c knowledge to achieve this goal already exists

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1

Page 4: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

35 000 000 people will die from chronic diseases

in 2005

Projected gloall ages, 2005

2 8

30 0

00 d

eath

s

1 6

07

00

0 d

eath

s

HIV/AIDS Tuberculosis

CHRONIC DISEASES ARE THEIN ALMOST ALL COUNTRIESChronic diseases include heart disease, stroke, cancer, chronic

respiratory diseases and diabetes. Visual impairment and blind-

ness, hearing impairment and deafness, oral diseases and genetic

disorders are other chronic conditions that account for a substantial

portion of the global burden of disease.

From a projected total of 58 million deaths from all causes in 2005,1

it is estimated that chronic diseases will account for 35 million,

which is double the number of deaths from all infectious diseases

(including HIV/AIDS, tuberculosis and malaria), maternal and peri-

natal conditions, and nutritional defi ciencies combined.1 The data presented in this overview were estimated by WHO using standard methods to maximize

cross-country comparability. They are not necessarily the offi cial statistics of Member States.

60%2

Page 5: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

lobal deaths by cause,

883 0

00 d

eath

s

17 5

28 0

00 d

eath

s

7 5

86

00

0 d

eath

s

4 0

57 0

00 d

eath

s

1 1

25

00

0 d

eath

s

MalariaCardiovascular

diseases Cancer

Chronicrespiratorydiseases Diabetes

HE MAJOR CAUSE OF DEATH

of all deaths are due to chronic diseases 3

Page 6: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

THE POOREST COUNTRIESARE THE WORST AFFECTEDOnly 20% of chronic disease deaths occur in high income countries

– while 80% occur in low and middle income countries, where most

of the world’s

population lives.

As this report will

show, even least

developed coun-

tries such as the

United Republic

of Tanzania are

not immune to the

growing problem.

of chronic disease deaths occur in low and middle income countries80%

Projected deaths by major cause andWorld Bank income group, all ages, 2005

Low incomecountries

Lower middleincome countries

Upper middleincome countries

High incomecountries

* Chronic diseases include cardiovascular diseases, cancers, chronic respiratory disorders, diabetes,neuropsychiatric and sense organ disorders, musculoskeletal and oral disorders, digestive diseases,genito-urinary diseases, congenital abnormalities and skin diseases.

Tota

l d

eath

s (0

00

)

14 000

12 000

10 000

8 000

6 000

4 000

2 000

0

Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies

Chronic diseases*

Injuries

4

Page 7: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Projected foregone national income due to heart disease, stroke and diabetes in selected countries, 2005–2015

Brazil Canada China India Nigeria Pakistan RussianFederation

UnitedKingdom

UnitedRepublic

of Tanzania

Inte

rna

tion

al

doll

ars

(b

illi

on

s)

600

500

400

300

200

100

0

THE PROBLEM HAS SERIOUS IMPACTThe burden of chronic disease:

has major adverse effects on the quality of life of affected individuals;

causes premature death;

creates large adverse – and underappreciated – economic effects on families, communities and societies in general.

»

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$558 billionThe estimated amount China will forego in national income over the next 10 years as a result of premature deaths caused by heart disease, stroke and diabetes 5

Page 8: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

THE RISK FACTORSARE WIDESPREADCommon, modifi able risk factors underlie the major chronic diseases. These risk

factors explain the vast majority of chronic disease deaths at all ages, in men and

women, and in all parts of the world. They include:

unhealthy diet;

physical inactivity;

tobacco use.

Each year at least:

4.9 million people die as a result

of tobacco use;

2.6 million people die as a result

of being overweight or obese;

4.4 million people die as a result

of raised total cholesterol levels;

7.1 million people die as a result

of raised blood pressure.

»

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THE THREATIS GROWINGDeaths from infectious diseases, maternal and peri-

natal conditions, and nutritional defi ciencies com-

bined are projected to decline by 3% over the next

10 years. In the same period, deaths due to chronic

diseases are projected to increase by 17%.

This means that of the projected 64 million people

who will die in 2015, 41 million will die of a chronic

disease – unless urgent action is taken.

1 000 000 000people are overweight

6

Page 9: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

THE GLOBAL RESPONSE IS

INADEQUATE

1 Health and the Millennium Development Goals. Geneva, World Health Organization, 2005.

Despite global successes, such as the WHO Framework Convention on Tobacco

Control, the fi rst legal instrument designed to reduce tobacco-related deaths and

disease around the world, chronic diseases have generally been neglected in inter-

national health and development work.

388 000 000people will die in the next 10 years

of a chronic disease

gets and indicators to include chronic diseases

and/or their risk factors; a selection of these

countries is featured in Part Two.

This report will demonstrate that chronic dis-

eases hinder economic growth and reduce the

development potential of countries, and this

is especially true for countries experiencing

rapid economic growth, such as China and

India. However, it is important that prevention

is addressed within the context of international

health and development work even in least

developed countries such as the United Republic

of Tanzania, which are already undergoing an

upsurge in chronic disease risks and deaths.

Furthermore, chronic diseases – the

major cause of adult illness and death

in all regions of the world – have not

been included within the global Millen-

nium Development Goal (MDG) targets;

although as a recent WHO publication

on health and the MDGs has recognized,

there is scope for doing so within Goal

6 (Combat HIV/AIDS, malaria and other

diseases). Health more broadly, including

chronic disease prevention, contributes

to poverty reduction and hence Goal 1

(Eradicate extreme poverty and hunger).1

In response to their needs, several coun-

tries have already adapted their MDG tar-

7

Page 10: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

10Projected global distributionof chronic disease deathsby World Bank income group,all ages, 2005

Upper middle income countries

8%

High incomecountries

20%Low income

countries35%

Lower middle income countries

37%

Several misunderstandings

have contributed to the

neglect of chronic disease.

Notions that chronic dis-

eases are a distant threat

and are less important and

serious than some infectious

diseases can be dispelled

by the strongest evidence.

Ten of the most common

misunderstandings are pre-

sented below.

MISUNDERSTANDING MISUNDERSTANDING CHRONIC

DISEASES MAINLY AFFECT

HIGH INCOME COUNTRIES

Whereas the common notion

is that chronic diseases mainly

affect high income countries,

the reality is that four out of fi ve

chronic disease deaths are in

low and middle income countries.

MISUABOUT CHRONIC DISEASE – AND THE REALITY

8

Page 11: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Projected death rates by specific causefor selected countries, all ages, 2005

Brazil Canada China India Nigeria Pakistan RussianFederation

UnitedKingdom

UnitedRepublic of

Tanzania

Ag

e-st

an

da

rdiz

ed d

eath

ra

tes

(per

10

0 0

00

)

700

600

500

400

300

200

100

0

HIV/AIDS, tuberculosis and malaria

Cardiovascular diseases

MISUNDERSTANDING MISUNDERSTANDING

Many people believe that low and middle income coun-

tries should control infectious diseases before they

tackle chronic diseases. In reality, low and middle income countries are at the centre of both old and new public health challenges. While they con-

tinue to deal with the problems of infectious diseases,

they are in many cases experiencing a rapid upsurge in

chronic disease risk factors and deaths, especially in

urban settings. These risk levels foretell a devastating

future burden of chronic diseases in these countries.

SUNDERSTANDINGS

9

Page 12: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Roberto Severino Campos lives in a shanty town in

the outskirts of São Paulo with his seven children

and 16 grandchildren. Roberto never paid atten-

tion to his high blood pressure, nor to his drinking

and smoking habits. “He was so stubborn,” his

31-year-old daughter Noemia recalls, “that we

couldn’t talk about his health”.

Roberto had his fi rst stroke six years ago at the age of 46 – it para-

lysed his legs. He then lost his ability to speak after two consecutive

strokes four years later. Roberto used to work as a public transport

agent, but now depends entirely on his family to survive.

ROBERTO SEVERINO CAMPOS MISUNDERSTANDING MISUNDERSTANDING

CHRONIC DISEASES

MAINLY AFFECT

RICH PEOPLEMany people think that

chronic diseases mainly

affect rich people. The truth

is that in all but the least

developed countries of

the world, poor people are

much more likely than the

wealthy to develop chronic

diseases, and everywhere

are more likely to die as

a result. Moreover, chronic

diseases cause substantial

financial burden, and can

push individuals and house-

holds into poverty.

Page 13: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Since Roberto’s fi rst stroke, his

wife has been working long hours as a cleaner

to earn money for the family. Their eldest son is

also helping with expenses. Much of the family’s

income is used to buy the special diapers that

Roberto needs. “Fortunately his medication and

check-ups are free of charge but sometimes we

just don’t have the money for the bus to take us

to the local medical centre,” Noemia continues.

But the burden is even greater: this family not

only lost its breadwinner, but also a devoted

Name Roberto Severino

Campos

Age 52

Country Brazil

Diagnosis Stroke

face to faceWITH CHRONIC DISEASE:

STROKE

father and grandfather,

in whom each family

member could confi de.

Roberto is now trapped in his own body and always

needs someone to feed him and see to his most basic

needs. Noemia carries him in and out of the house so

he can take a breath of air from time to time. “We all

wish we could get him a wheelchair,” she says.

Noemia and four of her brothers and sisters also suffer

from high blood pressure.

People who are already poor are the most likely to suffer

fi nancially from chronic diseases, which often deepen

poverty and damage long-term economic prospects.

BRAZIL

11

Page 14: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

MISUNDERSTANDING

Chronic diseases are often viewed as primarily affecting old people. We now know that

almost half of chronic disease deaths occur prematurely, in people under 70 years

of age. One quarter of all chronic disease deaths occur in people under 60 years of age.

Projected chronic disease death ratesfor selected countries, aged 30–69 years, 2005

Brazil

Canad

a

China

Indi

a

Niger

ia

Paki

stan

Russi

an

Fede

ratio

nUni

ted

Kingd

om

Unite

d Rep

ublic

of Ta

nzan

ia

Ag

e-st

an

da

rdiz

ed d

eath

ra

tes

(per

100 0

00)

1000

800

600

400

200

0

In low and middle income countries, middle-

aged adults are especially vulnerable to

chronic disease. People in these countries

tend to develop disease at younger ages,

suffer longer – often with preventable

complications – and die sooner than those

in high income countries.

Childhood overweight and obesity is a ris-

ing global problem. About 22 million chil-

dren aged under fi ve years are overweight.

In the United Kingdom, the prevalence

of overweight in children aged two to

10 years rose from 23% to 28% between 1995

and 2003. In urban areas of China, overweight

and obesity among children aged two to six

years increased substantially from 1989

to 1997. Reports of type 2 diabetes in

children and adolescents – previously

unheard of – have begun to mount

worldwide.

12

Page 15: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

MALRI TWALIB IS A FIVE-

YEAR-OLD BOY living in

a poor rural area of the

Kilimanjaro District of the

United Republic of Tanzania. Health workers from a nearby medical centre spotted

his weight problem last year during a routine community outreach activity. The

diagnosis was clear: childhood obesity.One year later, Malri’s health condition hasn’t changed for the better and neither has his excessive consumption of

porridge and animal fat. His fruit and vegetable intake also remains seriously insuffi cient – “it is just too hard to fi nd

reasonably priced products during the dry season, so I can’t manage his diet,” his mother Fadhila complains.

The community health workers who recently visited Malri for a follow-up also noticed that he was holding the same

fl at football as before – the word “Health” stamped on it couldn’t pass unnoticed. Malri’s neighbourhood is littered with

sharp and rusted construction debris and the courtyard is too small for him to be

able to play ball games. In fact, he rarely plays outside. “It is simply too hazardous.

He could get hurt,” his mother says.

Name Malri Twalib

Age 5

Country United Republic of

Tanzania

Diagnosis Obesity

MALRI TWALIB

THE NEXTGENERATION

Children like Malri cannot choose the environment in which

they live nor what they eat. They also have a limited ability to

understand the long-term consequences of their behaviour.

Fadhila, who is herself obese, believes

that there are no risks attached to her

son’s obesity and that his weight will

naturally go down one day. “Rounded

forms run in the family and there’s

no history of chronic diseases, so

why make a big fuss of all this,” she

argues with a smile on her face. In

fact, Malri and Fadhila are at risk of

developing a chronic disease as a

result of their obesity.

13

Page 16: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

MISUNDERSTANDING

CHRONIC

DISEASES AFFECT

PRIMARILY MENCertain chronic diseases,

especially heart disease,

are often viewed as

primarily affecting men.

The truth is that chronic diseases, including

heart disease, affect women and men

almost equally.

Projected globalcoronary heartdisease deathsby sex, all ages,

2005

Women47%

MenMen53%53%

Some 3.6 million women will die from coronary heart

disease in 2005. More than eight out of 10 of these

deaths will occur in low and middle income countries.

14

Page 17: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Menaka Seni had bypass surgery following

a heart attack last year – exactly a year

after her husband died from one – and

survived the tsunami which devastated

her neighbourhood in December 2004.

Despite these ordeals, she has been able

to “get back on track”, she says, and to

make positive changes to her life.

Shortly after her husband’s death, Menaka

started taking daily walks to the temple, but

MENAKA SENIMENAKA SENI

GETTING BACK ON TRACK

Name Menaka Seni

Age 60

Country India

Diagnosis Heart disease and diabetes

was still eating unhealthily at the time of her heart attack.

“I may be one of the privileged who could seek the best

medical treatment, but what really matters from now on is

how I behave,” she argues. Menaka has been eating more

fi sh, fruit and vegetables since the surgery.

Related to her heart disease and diabetes, Menaka is

overweight and suffers from high blood pressure. “Taking

medication for my heart and diabetes helps but it takes

more than that. You also need to change behaviour to

lower your health risks,” she explains.

Menaka recently turned 60 and is successfully managing

both her diet and daily physical activity. The medical staff

who took care of her while she was recovering in hospital

played a key role in convincing her of the benefi ts of eating

well and exercising regularly.

80% OF PREMATURE HEART DISEASE, 80% OF PREMATURE HEART DISEASE, STROKE AND DIABETES CAN BE PREVENTEDSTROKE AND DIABETES CAN BE PREVENTED

face to faceWITH CHRONIC DISEASE:

HEART DISEASE AND DIABETES

15

Page 18: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

MISUNDERSTANDING MISUNDERSTANDING

CHRONIC DISEASES

ARE THE RESULT

OF UNHEALTHY

“LIFESTYLES”Many people believe that if individuals develop chronic disease as a result of unhealthy “lifestyles”, they have no one to blame but themselves. The truth is that individual responsibility can have its full effect only where individu-als have equitable access to a healthy life, and are sup-ported to make healthy choices. Gov-ernments have a crucial role to play in improving the health and well-being of populations, and in providing special protection for vulnerable groups.

This is especially true for children, who cannot choose the environment in which they live, their diet and their passive exposure to tobacco smoke. They also have a limited ability to understand the long-term conse-quences of their behaviour.

Poor people also have limited choices about the food they eat, their living conditions, and access to education and health care. Sup-porting healthy choices, especially for those who could not otherwise afford them, reduces risks and social inequalities.

FOR THE PAST 20 YEARS, Faiz

Mohammad has been a victim

of the misunderstand-

ings surrounding his

condition. He married two years after being

diagnosed with diabetes, and remembers the

difficulty he had in obtaining the blessing of

his future parents-in-law. “They were quite

reluctant to give their daughter to someone

with diabetes. They didn’t trust me. They thought

I couldn’t support a family,” Faiz explains.

A hard-working livestock keeper and a father of three boys, Faiz considers

that at 48 he’s living a normal life. However, even after all this time, he still

encounters all sorts of obstacles that he fi nds diffi cult to overcome. “People

don’t understand why I suddenly became ill. They think I have done something

wrong and that I’m being punished.”

Faiz himself has misunderstandings about his disease. He wrongly believes

that diabetes is contagious and that he could transmit it sexually to his wife.

“I’m afraid of contaminating her because people keep telling me that I will,”

he says.

Faiz has a check-up and buys insulin every two months at a local clinic. He

claims that he is not receiving clear information about his disease and wishes

he knew where to fi nd answers to all his questions.

FAIZ MOHAMMAD“PEOPLE DON’T UNDERSTANDWHY I BECAME ILL”

Name Faiz Mohammad

Age 48

Country Pakistan

Diagnosis Diabetes

PAKISTAN

face to faceWITH CHRONIC DISEASE:

DIABETES

16

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More than three quarters of diabetes-related deaths

occur in low and middle income countries.

Page 20: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

MISUNDERSTANDING MISUNDERSTANDING

CHRONIC DISEASES CAN’T BE PREVENTEDAdopting a pessimistic attitude, some

people believe that there is nothing that

can be done, anyway. In reality, the

major causes of chronic diseases

are known, and if these risk factors

were eliminated, at least

80% of all heart disease,

stroke and type 2 diabetes

would be prevented; over

40% of cancer would be prevented.

18

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Some people believe that the solutions for chronic disease prevention and control are too expensive to be fea-sible for low and middle income coun-tries. In reality, a full range of chronic disease inter-ventions are very cost-effective for all regions of the world, including sub-Saharan Africa. Many of these solutions are also inexpensive to imple-ment. The ideal components of a medication to prevent complications in people with heart disease, for example, are no longer covered by pat-ent restrictions and could be produced for little more than one dollar a month.

MISUNDERSTANDING MISUNDERSTANDING

CHRONIC DISEASE PREVENTION AND CONTROL

IS TOO EXPENSIVE

19

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In any population, there will be a

certain number of people who do

not demonstrate the typical pat-

terns seen in the vast majority.

For chronic diseases, there are two major types:

people with many chronic disease risk fac-tors, who nonetheless live a healthy and long life;

people with no or few chronic disease risk factors, who nonetheless develop chronic disease and/or die from complications at a young age.

These people undeniably exist, but they are rare. The vast majority of chronic disease can be traced back to the common risk factors, and can be prevented by elimi-nating these risks.

»

»

Another set of misunderstandings arises from kernels of truth. In these cases,

the kernels of truth are distorted to become sweeping statements that are not true. Because

they are based on the truth, such half-truths are among the most ubiquitous and persistent

misunderstandings. Two principal half-truths are refuted below.

HALF-TRUTH

“ My grandfather smoked and

was overweight –

and he lived to 96”

20

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Certainly everyone has to die of something, but death does not need to be slow, painful, or premature.

Most chronic diseases do not result in sudden death.

Rather, they are likely to cause people to become progres-

sively ill and debilitated, especially if their illness is not

managed correctly.

Death is inevitable, but a life of protracted ill-health is not.

Chronic disease prevention and control helps people to

live longer and healthier lives.

Everyone has to die of something

“ HALF-TRUTH

Page 24: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

DYING SLOWLY, PAINFULLY AND PREMATURELY

JONAS JUSTO KASSA

Name Jonas Justo Kassa

Age 65

Country United Republic of

Tanzania

Diagnosis Diabetes

face to faceWITH CHRONIC DISEASE:

DIABETES

BEFORE RETIRING as a mathematics teacher,

Jonas Justo Kassa worked on his land after

school hours and remembers that he was feel-

ing very tired and constantly urinating. “I just

assumed that I was working too hard, I wish I would have known

better,” he says with regret, 13 years down the road.

Despite these symptoms, Jonas waited several years before seeking help. “I fi rst went to

the traditional healer, but after months of taking the herb treatment he prescribed I wasn’t

feeling any better,” he recalls. “So a friend drove me to the hospital – a 90 minute drive

from here. I was diagnosed with diabetes in 1997.”

The next couple of years were an immense relief as Jonas underwent medical

treatment to stabilize his blood glucose levels. He also changed his diet and

stopped drinking under his doctor’s recommendations. But Jonas didn’t stick to

his healthier ways for long, and it led to health repercussions. “My legs started

to hurt in 2001. I couldn’t measure my blood sugar and from the remote slopes

of Kilimanjaro, it’s diffi cult to reach a doctor,” he explains.

The pain became much worse and complications that could have been avoided

unfortunately appeared. Jonas had his right and left legs amputated in

2003 and 2004. “I now feel doomed and lonely. My friends have

left me. I am of no use to them and my family anymore,” he said

with resignation before dying in his home, on 21 May 2005. Jonas

was 65 years old.

22

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Page 26: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

However, it is by no means a future without hope.

For another of today’s realities, equally well sup-

ported by the evidence, is that the means to prevent

and treat chronic diseases, and to avoid millions

of premature deaths and an immense burden of

disability, already exist.

In several countries, the application of existing

knowledge has led to major improvements in the

CHRONIC DISEASES CAN BE PREVENTED AND CONTROLLED

life expectancy and quality of life of middle-

aged and older people. For example, heart

disease death rates have fallen by up to

70% in the last three decades in Australia,

Canada, the United Kingdom and the United

States. Middle income countries, such as

Poland, have also been able to make sub-

stantial improvements in recent years. Such

A VISION FOR REDUCING DEATHS AN

The rapid changes that threaten global health require a rapid response

that must above all be forward-looking. The great epidemics of tomor-

row are unlikely to resemble those that have previously swept the

world, thanks to progress in infectious disease control. While the risk

of outbreaks, such as a new infl uenza pandemic, will require constant

vigilance, it is the “invisible” epidemics of heart disease, stroke, diabe-

tes, cancer and other chronic diseases that for the foreseeable future

will take the greatest toll in deaths and disability.

24

Page 27: Preventing CHRONIC DISEASES a vital investment · Communicable diseases, maternal and perinatal conditions, and nutritional deficiencies Chronic diseases* Injuries 4. Projected foregone

Heart disease death rates amongmen aged 30 years or more, 1950–2002

1000

900

800

700

600

500

400

300

200

Ag

e-st

an

da

rdiz

ed d

eath

ra

tes

per

100 0

00

1950 1960 1970 1980 1990 2000 2010Year

Canada

Australia

USA

UK

R THE FUTURE:AND IMPROVING LIVES

gains have been realized largely as a

result of the implementation of com-

prehensive and integrated approaches

that encompass interventions directed

at both the whole population and indi-

viduals, and that focus on the com-

mon underlying risk factors, cutting

across specifi c diseases.

The cumulative total of lives saved through

these reductions is impressive. From 1970

to 2000, WHO has estimated that 14 million

cardiovascular disease deaths were averted

in the United States alone. The United King-

dom saved 3 million people during the same

period.

THE CHALLENGE IS NOW FOR OTHER COUNTRIES TO FOLLOW SUIT

25

BEYOND MISUNDERSTANDINGS: A VISION FOR THE FUTURE

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PREVENTING CHTHE GLOBAL ENCOURAGED BY ACHIEVEMENTS in countries

such as Australia, Canada, Poland, the United King-

dom and the United States, this report anticipates

more such gains in the years ahead. But realisti-

cally, how much is possible by the year 2015? After

carefully weighing all the available evidence, the

report offers the health community a new global

goal: to reduce death rates from all chronic diseases

by 2% per year over and above existing trends dur-

ing the next 10 years. This bold goal is thus in

addition to the declines in age-specifi c death rates

already projected for many chronic diseases, and

would result in the prevention of 36 million chronic

disease deaths by 2015, most of these being in

low and middle income countries. Achievement of

the global goal would also result in appreciable

economic dividends for countries.

36 000 000 lives26

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CHRONIC DISEASES: L GOAL FOR 2015

Every death averted is a bonus, but the goal

contains an additional positive feature: almost

half of these averted deaths would be in men

and women under 70 years of age and almost

nine out of 10 of these would be in low and

middle income countries. Extending these lives

for the benefi t of the individuals concerned,

their families and communities is in itself the

worthiest of goals.

Estimated global deaths avertedunder the global goal scenario

Low and middleincome countries

High income countries World

Dea

ths

(million

s)

40

35

30

25

20

15

10

5

0

Deaths averted among people aged 70 years or more

Deaths averted among people under 70 years of age

es can be saved

This global goal is ambitious and adventur-

ous, but it is neither extravagant nor unre-

alistic. The means to achieve it, based on

evidence and best practices from countries

that have made improvements, are outlined

in Parts Three and Four of this report.

BEYOND MISUNDERSTANDINGS: A VISION FOR THE FUTURE

27

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Every country, regardless of the level of its resources, has

the potential to make signifi cant improvements in chronic

disease prevention and control, and to take steps towards

achieving the global goal. Resources are necessary, but

a large amount can be achieved for little cost, and the

benefits far outweigh

the costs. Leadership is

essential, and will have

far more impact than

simply adding capital

to already overloaded

health systems.

123

PLANNING STEP 1Estimate population need and advocate for action

PLANNING STEP 2Formulate and adopt policy

PLANNING STEP 3Identify policy implementation steps

Policy implementation

steps

Population-wide interventions

Interventions for individuals

National level

Sub-national level

Implementation step 1

COREInterventions that are feasible to implement with existing resources in the short term.

Implementation step 2

EXPANDEDInterventions that are possible to implement with a realistically projected increase in or reallocation of resources in the medium term.

Implementation step 3

DESIRABLEEvidence-based interventions which are beyond the reach of existing resources.

123

The stepwise framework

taking

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There is important work to be done in countries at all stages of development.

In the poorest countries, many of which are experiencing upsurges in chronic

disease risks, it is vital that supportive policies are in place to reduce risks

and curb the epidemics before they take hold. In countries with established

chronic disease problems, additional measures will be required, not only to

prevent disease, but also to manage illness and disability.

Part Four of this report details the stepwise framework for implementing

recommended measures. The framework offers a fl exible and practical public

health approach to assist ministries

of health to balance diverse needs

and priorities while implementing

evidence-based interventions.

While there cannot be a “one size

fi ts all” prescription for implementa-

tion – each country must consider

a range of factors in establishing

priorities – using the stepwise

framework will make a major contri-

bution to the prevention and control

of chronic disease, and will assist

countries in their efforts to achieve

the global goal by 2015.

In many ways, we are the heirs of the choices In many ways, we are the heirs of the choices

that were made by previous generations: poli-that were made by previous generations: poli-

ticians, business leaders, fi nanciers and ordi-ticians, business leaders, fi nanciers and ordi-

nary people. Future generations will in turn be nary people. Future generations will in turn be

affected by the decisions that we make today. affected by the decisions that we make today.

Each of us has a choice: whether

to continue with the status quo,

or to take up the challenge and

invest now in chronic disease

prevention.

a fi nal word

BEYOND MISUNDERSTANDINGS: A VISION FOR THE FUTURE

2929

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Without action, an estimated 388 million

people will die from chronic diseases in

the next 10 years. Many of these deaths

will occur prematurely, affecting families,

communities and countries.

The macroeconomic impact will be

substantial. Countries such as China,

India and the Russian Federation

could forego between

$200 billion and $550

billion in national income

over the next 10 years as a result of

heart disease, stroke and diabetes.

30

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With increased investment in chronic disease prevention, as outlined in this

report, it will be possible to prevent 36 million premature deaths in the next

10 years. Some 17 million of these prevented deaths would be among people

under 70 years of age.

These averted deaths would also translate into substantial gains in countries’

economic growth. For example, achievement of the global goal would result

in an accumulated economic growth of $36 billion in China, $15 billion in India

and $20 billion in the Russian Federation over the next 10 years.

The failure to use available knowledge about chronic disease prevention and

control needlessly endangers future generations. There is simply no justifi -

cation for chronic diseases to continue taking millions of lives prematurely

each year while being overlooked on the health development agenda, when

the understanding of how to prevent these deaths is available now.

Taking up the challenge of chronic disease prevention and control requires a

certain amount of courage and ambition. The agenda is broad and bold, but

the way forward is clear.

THE CAUSES ARE KNOWN. THE WAY FORWARD IS CLEAR.IT’S YOUR TURN TO TAKE ACTION.

31